Second, female urologists have an extremely high use of ART. In addition, this rate did not take into account women who used ART and were unsuccessful in becoming pregnant, so the number is likely to be even higher. Given that our pregnancy group spans 40 years and ART was not as prevalent in the past, our results likely underestimate the current use by female urologists. But this is not surprising for many reasons. As women age, the rate of spontaneous pregnancy decreases. In fact, as noted in the obstetrics literature,infertility rates increase after the age of 30 years. Compared with women ages 20 to 24, fertility is reduced by 6% in the next 5 years, by 14% between ages 30 and 34,by 31% between ages 35 and 39, and to a much greater extent after age 40.The advanced maternal age of our group is clearly a factor for the high use of ART. Also,women physicians may be more aware of options for pregnancy and more likely to have the resources and finances to seek care. Our group is educated, of a good socioeconomic class, and knowledgeable about medical options, which undoubtedly played a role. In fact, women physicians of more advanced maternal ages may be offered ART when the general older population may not, simply because of relationships with physicians they know and access to resources not always offered to the general older or more complicated population.